Evidence and knowledge gaps on the disease burden in sexual and gender minorities: a review of systematic reviews

Abstract

Sexual and gender minorities (SGM) include individuals with a wide range of sexual orientations, physical characteristics, and gender identities and expressions. Data suggest that people in this group face a significant and poorly understood set of additional health risks and bear a higher burden of some diseases compared to the general population. A large amount of data is available on HIV/AIDS, but far less on other health problems. In this review we aimed to synthesize the knowledge on the burden of communicable and non-communicable diseases, mental health conditions and violence experienced by SGM, based on available systematic reviews. We conducted a global review of systematic reviews, including searching the Cochrane and the Campbell Collaboration libraries, as well as PubMed, using a range of search terms describing the populations of interest, without time or language restrictions. Google Scholar was also scanned for unpublished literature, and references of all selected reviews were checked to identify further relevant articles. We found 30 systematic reviews, all originally written in English. Nine reviews provided data on HIV, 12 on other sexually transmitted infections (STIs), 4 on cancer, 4 on violence and 3 on mental health and substance use. A quantitative meta-analysis was not possible. The findings are presented in a narrative format. Our review primarily showed that there is a high burden of disease for certain subpopulations of SGM in HIV, STIs, STI-related cancers and mental health conditions, and that they also face high rates of violence. Secondly, our review revealed many knowledge gaps. Those gaps partly stem from a lack of original research, but there is an equally urgent need to conduct systematic and literature reviews to assess what we already know on the disease burden in SGM. Additional reviews are needed on the non-biological factors that could contribute to the higher disease burden. In addition, to provide universal access to health-care for all, more information is needed on the barriers that SGM face in accessing health services, including the attitudes of health-care providers. Understanding these barriers and the additional health risks they impose is crucial to improving the health status of SGM.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0304-1) contains supplementary material, which is available to authorized users.

Violence motivated by perception of sexual orientation and gender identity: a systematic review

“…A review of systematic reviews showed that sexual and gender minorities are highly burdened by human immunodeficiency virus infection, sexually transmitted infections, sexually transmitted infection-related cancers, mental health conditions and violent experiences 105 . We suggest further research into the associations of violence motivated by perception of sexual orientation and gender identity with adverse health and social outcomes, including criminalization.…”

Co‐producing knowledge of lesbian, gay, bisexual, trans and intersex (LGBTI) health‐care inequalities via rapid reviews of grey literature in 27 EU Member States

“…In relation to conversion therapy, health professionals’ assumptions framing LGBT identities as ‘disorders’ were based on dated diagnoses that were removed from the psychiatric systems of diagnosis and classification (DSM and ICD) as part of the demedicalization of sexual orientation . This lack in knowledge supports the need for education and training of health professionals widely reported in research to question normativity and promote more inclusive health‐care practices for LGBT people . Health professionals will benefit from further education and training to help them navigate their way through changing terminology and complex health‐care systems.…”

“…Health inequalities are documented in a range of areas including increased rates of HIV and STIs in gay, bisexual and other men who have sex with men . Also, reviews of studies on weight discrepancies in LGB people showed a higher risk of raised weight increasing sequentially with age .…”

“…International research trends suggest that LGB people are at a higher risk of developing certain types of cancer commonly diagnosed at a younger age compared with the general population, where gay and bisexual men are twice as likely to report a diagnosis of anal cancer with those who are HIV‐positive being at the highest risk . Those LGB people who survived cancer may benefit from additional support post‐treatment to help them regain a sense of well‐being …”

Recruiting Hard-to-Reach Populations for Survey Research: Using Facebook and Instagram Advertisements and In-Person Intercept in LGBT Bars and Nightclubs to Recruit LGBT Young Adults (Preprint)

“…Elevated risk of tobacco use among LGBT individuals has been attributed to LGBT targeted tobacco product marketing [4,[9][10][11][12] and minority stress (ie, strain resulting from stigma and discrimination associated with having a minority identity) [13][14][15][16][17].…”